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Imaging in head and neck surgery
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Three structures form the hypopharynx: Pyriform sinus: This is the anterolateral recess located posterolateral to the aryepiglottic fold, and the inferior apex is at the level of the true vocal cord.Posterior pharyngeal wall: Inferior continuation of the posterior oropharyngeal wall.Post cricoid region: Junction of pharynx and oesophagus.
Management of Hypopharyngeal Cancer
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Prathamesh S. Pai, Deepa Nair, Sarbani Ghosh Laskar, Kumar Prabhash
The pyriform sinus is a funnel-shaped lateral channel on either side of the larynx beginning at the level of the pharyngoepiglottic fold. It has a lateral wall which is contiguous with the posterior pharyngeal wall, a medial wall that forms part of the aryepiglottic fold converging into the postcricoid mucosa medially, and opens posteriorly into the lumen of the pharynx.
In-clinic procedures
Published in Declan Costello, Guri Sandhu, Practical Laryngology, 2015
Nancy Solowski, Greg Postma, Paul Weinberger
Initially, there was some fear that in-clinic procedures, such as transnasal oesophagoscopy, would create opportunities for increased complications. This has been shown not to be the case, and it is generally accepted that transnasal oesophagoscopy is well tolerated by patients and has a low complication rate. In a large retrospective study of patients undergoing transnasal oesophagoscopy for diagnostic oesophagoscopy, Postma et al. (see Further reading) found no major complications and a minor complication rate of 1.1%. Complications in these 700 patients included six cases of self-limited epistaxis and two vasovagal episodes. Similarly, Dumortier et al. (see Further reading) reported a very low incidence of complications in a series of 1,100 patients undergoing transnasal oesophagoscopy in France. These studies provide evidence consistent with transnasal oesophagoscopy being of equivalent safety to sedated oesophagoscopy. There are additionally several cogent arguments suggesting transnasal oesophagoscopy may indeed be safer than rigid or sedated flexible endoscopy. Patients undergoing transnasal oesophagoscopy are alert and more able to protect their airway in the event of regurgitation. Similarly, in sedated flexible or rigid oesophagoscopy the pyriform sinus can be perforated while trying to advance the endoscope into the oesophageal inlet; however, during transnasal oesophagoscopy, patients are awake and may be able to alert the surgeon, as severe discomfort would be experienced. Indeed, Tsao et al. (see Further reading) recommended transnasal oesophagoscopy over rigid oesophagoscopy during oesophageal screening in head and neck cancer patients to reduce the complication of oesophageal perforation.
Regularity of voice recovery and arytenoid motion after closed reduction in patients with arytenoid dislocation: a self-controlled clinical study
Published in Acta Oto-Laryngologica, 2020
Tingting Zheng, Zhewei Lou, Xiaxia Li, Yaoshu Teng, Yun Li, Xiaojiang Lin, Zhihong Lin
All patients were received oropharyngeal and laryngopharyngeal mucosa surface anesthesia before closed reduction under indirect laryngoscope. All operations were implemented by the same doctor. Laryngeal forceps were placed on the outside of arytenoid cartilage, inside of the pyriform sinus, immersed to the bottom of the pyriform sinus. Anterior dislocations were reduced with posterior-upward push on the arytenoids during phonation and posterior dislocations with anterior–upward push during inspiration. The procedure was performed no more than three times, repeated after one week unless the bilateral arytenoid cartilage was almost symmetrical, bowed vocal fold straighten in anterior dislocations and both vocal folds were of equal length in posterior dislocations. The patients were encouraged to talk more and make a voice while shaking the neck larynx from left to right. All patients tolerated the procedure well.
Transoral robotic surgery in patients with stage III/IV hypopharyngeal squamous cell carcinoma: treatment outcome and prognostic factor
Published in Acta Oto-Laryngologica, 2019
Young Min Park, Da Hee Kim, Min Seok Kang, Jae Yol Lim, Yoon Woo Koh, Se-Heon Kim
All 44 patients were male and the mean age was 66 years (range 44–88), and 30 patients (68.2%) had a history of alcohol use. The primary sites were pyriform sinus in 32 patients (72.7%), postcricoid in 1 patient (2.3%), and posterior pharyngeal wall in 11 patients (25%). The TNM stage of the tumor was III in 7 patients (15.9%) and IV in 37 patients (84.1%). The details of T classification and N classification of the tumor are summarized in Table 1. Postoperative pathologic examination revealed ECS in 20 patients (45.5%), LVI in 6 patients (13.6%), and PNI in 1 patient (2.3%). Surgical margin analysis showed that 13 patients (29.5%) had positive margins and 31 patients (70.5%) had negative margins. Postoperatively, 35 patients (79.5%) received adjuvant treatment. Thirty-one patients (70.5%) underwent induction chemotherapy before surgery. Table 2 summarizes the other clinical characteristics of the patients.
A case of idiopathic thyroid abscess caused by Escherichia coli
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Gurbaj Singh, Radhika Jaiswal, Neha Gulati, Elizabeth Campbell Granieri
Once the diagnosis is established, treatment should be started immediately with antibiotics to avoid progression. Parenteral antibiotics alone are usually not sufficient to treat the abscess and surgical drainage is required in most cases, be it open surgical drainage or a more minimally invasive incision and drainage [2,15]. Needle aspiration under ultrasound guidance is reported to be successful in certain cases as well. Another alternative approach is placement of a percutaneous drainage catheters via either CT or sonographic guidance; this may be considered in simple abscesses with no loculations [14]. Surgical drainage may also afford the opportunity for management of predisposing anatomic factors at the same time to avoid recurrence. The pyriform sinus may be resected or obliterated during the surgery [16].